Abstract:

Objective To study the effects of different Epstein-Barr virus (EBV) DNA load, induction chemotherapy+radiotherapy and concurrent radiochemotherapy on patients with stage Ⅲ nasopharyngeal carcinoma (NPC). Methods A total of 178 patients with stage Ⅲ NPC were selected as the study subjects in the Department of Otorhinolaryngology of the First People's Hospital of Xianning of Hubei Province from January 2012 to March 2019, including 44 patients received adjuvant chemotherapy. According to the pre-treatment EBV DNA load of 1 000 copies/ml, the patients were divided into high viral load group (EBV DNA≥1 000 copies/ml, n=53) and low viral load group (EBV DNA<1 000 copies/ml, n=125), and 14 patients in the high viral load group and 30 patients in the low viral load group received adjuvant chemotherapy. According to treatment method, the patients were divided into induction chemotherapy+radiotherapy group (n=105) and concurrent radiochemotherapy group (n=73). The general clinical data, recurrence rate, 5-year overall survival (OS) rate, disease free survival (DFS) rate, local recurrence free survival (LRFS) rate and disease metastasis-free survival (DMFS) rate of each group were compared. Results Among 178 patients with stage Ⅲ NPC, 34 cases recurred, accounting for 19.10%, and 29 cases died, accounting for 16.29%. There was a statistically significant difference in N staging between the induction chemotherapy+radiotherapy group and the concurrent radiochemotherapy group (χ²=6.40, P=0.01). The tumor recurrence rate in the high viral load group was 33.96% (18/53), and that in the low viral load group was 12.80% (16/125), and there was a statistically significant difference (χ²=10.79, P<0.01). The recurrence rate of lymph nodes [(9.43% (5/53) vs. 1.60% (2/125), χ²=4.15, P=0.04], the distant metastasis rate [18.87% (10/53) vs. 5.60% (7/125), χ²=7.59, P=0.01] were significantly higher than those in the low viral load group, and there were statistically significant differences. The tumor recurrence rate of patients in the induction chemotherapy+radiotherapy group was 17.14% (18/105), and that in the concurrent radiochemotherapy group was 21.91% (16/73), and there was no statistically significant difference (χ²=0.63, P=0.43). The 5-year OS rate, DFS rate, LRFS rate and DMFS rate of 178 patients with stage Ⅲ NPC were 84.68%, 72.80%, 79.68% and 79.54%, respectively. The 5-year OS rate (79.25% vs. 92.80%, χ²=6.86, P<0.01), DFS rate (73.58% vs. 88.00%, χ²=5.67, P=0.01), LRFS rate (73.21% vs. 89.24%, χ²=8.32, P<0.01) and DMFS rate (65.24% vs. 78.00%, χ²=4.15, P=0.02) in the high viral load group were significantly lower than those in the low viral load group, and there were statistically significant differences. The 5-year OS rate (89.52% vs. 87.67%, χ²=0.15, P=0.70), DFS rate (84.76% vs. 82.19%, χ²=0.21, P=0.65), LRFS rate (80.38% vs. 79.84%, χ²=0.00, P=1.00) and DMFS rate (79.52% vs. 81.78%, χ²=0.05, P=0.83) in the induction chemotherapy+radiotherapy group were not statistically significant compared with those in the concurrent radiochemotherapy group, and there were no statistically significant differences. The 5-year OS rate of 44 patients receiving adjuvant chemotherapy was significantly higher than that of patients who did not receive adjuvant chemotherapy (93.77% vs. 87.49%), and there was a statistically significant difference (χ²=5.21, P=0.02). In the high viral load group, the 5-year OS rate of patients receiving adjuvant chemotherapy was significantly higher than that of patients who did not receive adjuvant chemotherapy (93.77% vs. 84.13%), and there was a statistically significant difference (χ²=5.11, P=0.03). Conclusion Induction chemotherapy+radiotherapy can achieve the same therapeutic effect as concurrent radiochemotherapy. High viral load is associated with high recurrence rate and poor survival rate. For these patients with high viral load, treatment intensity needs to be strengthened.

Key words: Nasopharyngeal neoplasms, Herpesvirus 4, human, Chemoradiotherapy